Post on 13-Dec-2015
FIGURE 1. URETHRAL DISCHARGE
Treatment of Urethral DischargeGonorrhea Chlamydia
Ciprofloxacin 500mg orally x 1 dose Azithromycin 1g orally x 1 dose
Cefixime 400mg orally x 1 dose Doxycycline 100mg orally twice daily x 7 days
Ceftriaxone 250mg IM x 1 dose Amoxicillin 500mg orally three times daily x 7 days
Spectinomycin 2g IM x 1 dose Erythromycin 400mg orally four time daily x 7 daysOfloxacin 300mg orally twice daily x 7daysTetracycline 500mg orally four times daily x 7 days
*Fluoroquinolones and tetracyclines are contraindicated in pregnancy
N.B. This flowchart assumes effective therapy for Gonorrhoea and Chlamydia to have been received and taken by the patient prior to this consultation.
FIGURE 2. PERSISTENT/RECURRENTURETHRAL DISCHARGE IN MEN
Trichomonas Vaginalis
• Treatment:– Metronidazole 500mg orally twice daily x 7 days, OR– Tinidazole 500mg orally twice daily x 5 days
1 Indications for syphilis treatment:- RPR positive; and- Patient has not been treated for syphilis recently.
2 Treat for HSV2 where prevalence is 30% or higher, or adapt to local conditions.
FIGURE 3. GENITAL ULCERS
Treatment of Genital UlcersHerpes Syphilis Chancroid
First Episode:Acyclovir 400mg orally three times daily x 7 days
Benzathine benzylpenicillin 2.4 MU IM x 1 dose
Azithromycin 1g orally x 1 dose
Valacyclovir 1g orally twice daily x 7 days
Procaine benzylpenicillin 1.2 MU IM daily x 10 doses
Ceftriaxone 250mg IM x 1 dose
Recurrent episode:Acyclovir 400mg orally three times daily x 5 days
Doxycycline 100mg orally twice daily x 15 days
Ciprofloxacin 500mg twice daily x 3 days
Valacyclovir 1g orally once daily x 5 days
Erythromycin base 500mg orally four times daily x 7 days
FIGURE 5. SCROTAL SWELLING
Treatment of Scrotal SwellingGonorrhea Chlamydia
Ciprofloxacin 500mg orally x 1 dose Azithromycin 1g orally x 1 dose
Cefixime 400mg orally x 1 dose Doxycycline 100mg orally twice daily x 7 days
Ceftriaxone 250mg IM x 1 dose Amoxicillin 500mg orally three times daily x 7 days
Spectinomycin 2g IM x 1 dose Erythromycin 400mg orally four time daily x 7 daysOfloxacin 300mg orally twice daily x 7daysTetracycline 500mg orally four times daily x 7 days
*Fluoroquinolones and tetracyclines are contraindicated in pregnancy
FIGURE 4. INGUINAL BUBO
Treatment of Inguinal Bubo
• Treat for both Chancroid and LGV– Ciprofloxacin 500mg orally twice daily x 3 daysAND– Doxycycline 100mg orally twice daily x 7 days
Risk factors need adaptation to local social, behavioural and epidemiological situation.
1 The determination of high prevalence levels needs to be made locally.
FIGURE 6. VAGINAL DISCHARGE
Treatment of Vaginal DischargeGonorrhea Chlamydia
Ciprofloxacin 500mg orally x 1 dose Azithromycin 1g orally x 1 dose
Cefixime 400mg orally x 1 dose Doxycycline 100mg orally twice daily x 7 days
Ceftriaxone 250mg IM x 1 dose Amoxicillin 500mg orally three times daily x 7 days
Spectinomycin 2g IM x 1 dose Erythromycin 400mg orally four time daily x 7 daysOfloxacin 300mg orally twice daily x 7daysTetracycline 500mg orally four times daily x 7 days
*Fluoroquinolones and tetracyclines are contraindicated in pregnancy
Bacterial Vaginosis
• Treatment:– Metronidazole 2g orally x 1 doseOR– Metronidazole 500mg orally twice daily x 7 daysOR– Clindamycin 300mg orally twice daily x 7 daysOR– Clindamycin or metronidazole gels vaginally
Candida
• Treatment:– Clotrimazole 500mg vaginally x 1 doseOR– Fluconazole 150mg orally x 1 dose
FIGURE 9. LOWER ABDOMINAL PAIN
Treatment of Pelvic Inflammatory Disease
• Treat for gonorrhea, chlamydia and anaerobes– Ceftriaxone 250mg IM x 1 dose
AND
– Doxycycline 100mg orally twice daily x 14 daysAND
– Metronidazole 500mg orally twice daily x 14 days
• Review patient in 3 days if treating as outpatient, if no improvement refer
FIGURE 10. NEONATAL CONJUNCTIVITIS
Treatment of Conjunctivitis in Infants
• Treat for Gonorrhea and Chlamydia– Ceftriaxone 50mg/kg (max 125mg) IM injection x 1
doseAND– Erythromycin syrup 50mg/kg/day orally, in 4
divided dose x 14 daysOR– Trimethoprim 40mg/Sulfamethoxazole 200mg
orally twice daily x 14 days